Utility of Functional Metrics Assessed During Acute Care on Hospital Outcomes: A Systematic Review.

The 30 studies were very different, and few used the same functional metric for the same outcome, so results cannot be combined into one clear answer. The review did not restrict studies by design, sample size, or population type, and most studies were moderate to poor quality with moderate to high detection bias and missing covariates. Many studies did not adjust for cognition or comorbidities, so reported associations may overestimate the true relationship. It is unclear which functional metric is best for which patient group or outcome, and unclear whether function at admission, change in function, or function before discharge is most useful. The Barthel Index and FIM require training and are lengthy, and the FIM has ceiling effects with dementia or severe brain injury and floor effects with neuromuscular disease or spinal cord injury.

Do not read these results as evidence that routine functional assessment will prevent poor hospital outcomes. The review found associations from published studies, and it did not test whether adding the assessment changed outcomes.